Left ventricular myocardial dysfunction in young and middle-aged ischemic stroke patients: the Norwegian stroke in the young study

BACKGROUND: Hypertension is highly prevalent in ischemic stroke patients, but less is known about its impact on subclinical left ventricular (LV) dysfunction in such patients. METHODS: Conventional and speckle tracking echocardiography was performed in 276 young (15-44 years) and middle-aged (45-60 years) ischemic stroke patients (mean age 50 ± 9 years, 66% men). Hypertension was defined as a history of hypertension, use of antihypertensive medications, persistently elevated blood pressure (BP) during hospitalization or elevated clinic BP (≥140/90 mmHg) and ambulatory BP (≥130/80 mmHg) at follow-up visits. LV myocardial dysfunction was assessed by peak systolic global longitudinal (GLS) and circumferential strain (GCS). RESULTS: Hypertension was present in 68% of patients and associated with higher age, BMI and LV mass, male sex and the presence of diabetes (all P < 0.01). Compared with normotensive patients, hypertensive patients had significantly lower peak systolic GLS (-16 ± 3 vs. -19 ± 2%, P < 0.001) and GCS (-16 ± 3 vs. -18 ± 4%, P < 0.001) while ejection fraction did not differ between groups (P = 0.134). In univariable regression analyses, reduced peak systolic GLS and GCS were both associated with hypertension (β = 0.43 and 0.29, respectively, both P < 0.001). The association with hypertension remained significant for GLS (β = 0.25) after adjustment for LV mass, ejection fraction, male sex, obesity and diabetes (multiple R = 0.35, P < 0.001), whereas the association of hypertension with reduced peak systolic GCS was attenuated. CONCLUSION: In ischemic stroke survivors, hypertension was associated with reduced peak systolic GLS but not GCS independent of confounders.